Collaborative Care Intervention Improves Side Effects, Quality of Life for Patients and Caregivers

Active screening and symptom management in patients with cancer reduces depression, pain, and fatigue, and improves quality of life for patients and their family caregivers, a study published in the journal Cancer has shown.1

Because effective palliative care can improve outcomes for patients and ease the burden of care for their caregivers, researchers sought to determine the efficacy of a collaborative care intervention on depression, pain, and fatigue and quality of life for patients with cancer and their family caregivers.

The intervention included a web site with written and audiovisual self-management strategies, a bulletin board, and other resources; visits with a care coordinator every 2 months, coinciding with a doctor's appointment; and telephone follow-up calls every 2 weeks. Primary outcomes measures included depression, pain, fatigue, and health-related quality of life for patients. Secondary outcomes included interleukin (IL)-1α, IL-β, IL-6, and IL-8 levels, and Natural Killer (NK) cell numbers in patients, and stress and depression in caregivers.

Researchers randomized 261 patients with advanced cancer and 179 family caregivers to the web-based collaborative care intervention or enhanced usual care. One or more symptoms reports were within the clinical range in 51% of the patients at baseline.

Of those patients with clinical levels of symptoms and who were randomized to the intervention, researchers observed reductions in depression, pain, and fatigue (Cohen's d = 0.71, 0.62, and 0.26, respectively) and improvements in quality of life (Cohen's d = 0.99) at 6 months, compared with the patients in the enhanced usual care arm. Reductions in IL-6 (ϕ = 0.18), IL-1β (ϕ = 0.35), IL-1α (ϕ = 0.19), and IL-8 (ϕ = 0.15) and increases in NK cell numbers (ϕ = 0.23) were observed in those participants in the intervention arm at 6 months, compared with those in the enhanced usual care arm.

Reduced stress and depression (Cohen's d = 0.75 and 0.37, respectively) were observed at 6 months in caregivers of those patients randomized to the intervention arm.

Based on these results, the researchers recommend integration of screening and symptom management into cancer care.